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All Seizures ALL about SEIZURES What is Epilepsy? Epilepsy is a neurological disorder – a physical condition – which causes sudden bursts of hyperactivity in the brain. This hyperactivity produces “seizures” which vary from one person to another in frequency and form. A seizure may appear as • a brief stare • a change of awareness • a convulsion A seizure may last a few seconds or a few minutes. Epilepsy • is not a disease • is not a psychological disorder • is not contagious Causes In approximately 60-75% of all cases, there is no known cause. Of the remaining cases, there are a number of fre- quently identified causes. Identifiable Causes • brain injury to the fetus during pregnancy • birth trauma (lack of oxygen) • aftermath of infection (meningitis) • head trauma (car accident, sports injury, shaken baby syndrome) • substance abuse • alteration in blood sugar (hypoglycemia) • other metabolic illness (hypocalcemia) • brain tumor • stroke Is There a Cure? Although treatments are available to reduce the frequency and severity of seizures, there is no known cure for epilepsy. Complex partial seizure: a person loses awareness as the Seizures seizure begins and appears dazed and confused. The person There are many different types of seizures. will exhibit meaningless behaviours such as random walk- ing, mumbling, head turning, or pulling at clothing. These Most are classified within 2 main categories: partial seizures behaviours cannot be recalled by the person after the seizure. and generalized seizures. Generalized Seizures Incidence of Seizure Types Generalized seizures occur when the excessive neural activi- ty in the brain encompasses the entire brain. The 2 most common forms are generalized absence seizures and tonic- clonic seizures. Complex Absence seizure: during this type of seizure a person may Partial 36% appear to be staring into space and his/her eyes may roll Simple upwards. This kind of seizure is characterized by 5 to 15 sec- Partial 14% ond lapses of consciousness and, when it has ended, the per- son will not recall this lapse of consciousness. Generalized absence seizures most often occur in childhood and disappear Absence Other Partial 6% 7% during adolescence. They are less prevalent in adulthood. Tonic-clonic seizure: during this seizure a person will usual- Myoclonic Other ly emit a short cry and fall to the floor. This cry does not 3% Generalized Unclassified Generalized 3% 8% Tonic-Clonic indicate pain. The muscles will stiffen and the body extrem- 23% ities will jerk and twitch (convulse). Bladder control may be lost. Consciousness is lost and may be regained slowly. Based on information from: Some medical conditions may cause seizures, these include: Epilepsy — A Comprehensive Textbook, J Engel Jr & TA Pedley, editors febrile seizures (caused by high fever in children), Lippincott-Raven, 1997. withdrawal seizures, and seizures caused by poisoning, aller- gic reaction, infection, or an imbalance of body fluids or Partial Seizures chemicals (low blood sugar). These are not considered to be forms of epilepsy. Partial seizures occur when the excessive neural activity in the brain is limited to one area. People who have lived with epilepsy for much of their lives may find that their seizures change as they age. The duration The 2 most common forms are: of their seizures may become longer or shorter; the intensity • simple partial seizures and may worsen or improve and seizure episodes may occur • complex partial seizures. more or less frequently. Seniors also demonstrate a high rate of newly-diagnosed cases of epilepsy. Simple partial seizure: a person may experience a range of strange or unusual movements or sensations, such as sudden While there is a 10% chance that a person will experience a jerky movements of one body part, distortions in sight or seizure at some time during their lifetime, a single seizure is smell, a sudden sense of fear or anxiety, stomach discomfort, not considered to be epilepsy. or dizziness. These sensations may be described as an aura. An aura is a simple partial seizure which can occur alone, or can be followed by a generalized seizure. Postictal States Diagnosing Epilepsy The “ictal” state is the time during which a seizure occurs. Postictal states commonly follow both tonic-clonic and Diagnosis of a seizure disorder is based on the individual’s complex partial seizures. As a person regains consciousness medical history and diagnostic testing results. after a seizure, s/he may experience fatigue, confusion and disorientation lasting minutes, hours or even days (or, rarely, longer). S/he may fall asleep or gradually become less con- Medical History fused until full consciousness is regained. A physician needs to know when the seizures started, and have a detailed description of an individual’s seizures. The For more information, please contact your local epilepsy family’s health history is also considered. association or visit www.epilepsyontario.org Diagnostic Tests Important CAT Scan Status epilepticus, is a prolonged or continuous Computerized Axial Tomography, also known as CT seizure state. It can be a life-threatening medical (Computed Tomography) imaging, is a safe and non-inva- emergency. sive procedure which uses low radiation X-rays to create a computer-generated, three-dimensional image of the brain. Status epilepticus can be convulsive (tonic- It provides detailed information clonic or myoclonic) or non-convulsive about the structure of the brain by (absence or complex partial). A person in non- using a series of X-ray beams to scan convulsive status epilepticus may appear con- the head to create cross-sectional fused or dazed. images of the brain. These may reveal abnormalities (blood clots, cysts, If a seizure lasts 5 minutes or more, or occur one tumours, scar tissue, etc.) in the brain after another without full recovery between which may be related to seizures. seizures – immediate medical care is required. This allows physicians to examine Call 911 this structure, section by section, as the test is being conduct- ed. The CAT scan helps to point to where a person's seizures originate. SUDEP Sudden Unexpected Death in Epilepsy EEG The exact cause of this syndrome is unknown, and yet accounts An electroencephalogram is a non- for 12–15% of sudden deaths among people living with invasive test which detects and epilepsy. It most often strikes those between 20 and 40 years of records electrical impulses on the sur- age who have experienced seizures for more than a year. face of the brain. These impulses are transmitted from small metal discs, Additional research and greater awareness about SUDEP is placed on the person’s scalp, through necessary. Autopsies reveal that 50% of affected patients had wires which are connected to an elec- AED blood concentrations either below therapeutic levels or troencephalograph. This instrument in completely undetectable amounts. It is unknown whether is used to register this activity and this is a result of poor compliance or metabolic issues. record it on graph paper or on a computer screen. This is a safe and painless procedure. areas that may generate seizures. No X-rays or radioactive materials An EEG is used by a neurologist to determine whether there are used, therefore this procedure is is any irregular electrical activity occurring in the brain not known to be harmful. which may produce seizures. It can help identify the loca- tion, severity, and type of seizure disorder. Because seizures can arise from scar tissue in the brain, an MRI offers An abnormal EEG does not diagnose epilepsy nor does a doctors the best chance of finding normal EEG reading exclude it. the source of seizures. An MRI can show scar tissue and allow doctors to determine the nature of it. The images pro- duced from the MRI are extremely precise. The information MEG/MSI provided by MRI is valuable in the diagnosis and treatment Magnetoencephalography, also of individuals with epilepsy and in determining whether sur- called Magnetic Source Imaging, gery would be beneficial. is a non-invasive scanning tech- nique which provides information about the function of the brain. It MSRI is a safe and painless procedure Magnetic Resonance Spectroscopic Imaging is similar to that detects small biomagnetic sig- MRI but while MRI looks at the signals detected from the nals produced by the brain, record- protons of water in the body, MRSI looks at the signals ing magnetic fields over the surface detected from other proton-containing metabolites. of the head. These signals provide information about the location of active brain areas. This technique allows doctors to investigate how different areas PET of the brain interact with one another. Positron Emission Tomography is a scanning technique which detects MEG can help to identify brain zones which emit abnormal chemical and physiological electric currents associated with epilepsy. It can “see” the changes related to metabolism. It magnetic fields associated with sensory areas of the brain by produces 3-dimensional images of stimulating the senses during MEG recording sessions. It blood flow, chemical reactions and views the brain zones which control language by having the muscular activity in the body as patient perform linguistic tasks during an MEG; and, identi- they occur. It measures the intensi- fy the brain zones associated with learning and memory by ty of the use (metabolization) of glucose, oxygen or other having the patient perform cognitive tasks during an MEG. It substances in the brain. is useful in planning surgical treatment of epilepsy and for pre-surgical functional mapping of the brain. It quickly pro- This allows the neurologist to study the function of the brain. vides high resolution images of the brain, used to compare By measuring areas of blood flow and metabolism, the PET function in relationship to behaviour. scan is used to locate the site where a seizure originates. The PET scan provides information about metabolic activi- MRI ties, chemistry or blood flow by detecting how quickly tis- Magnetic Resonance Imaging is a safe and non-invasive sues absorb radioactive isotopes.
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